Pharmacist 1
 Spectraforce Technologies | |||||||||||||||||||||||||||
$200.00
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 United States, North Carolina, Raleigh | |||||||||||||||||||||||||||
| 500 West Peace Street (Show on map) | |||||||||||||||||||||||||||
 Dec 14, 2024 | |||||||||||||||||||||||||||
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Title: Pharmacist 1 Duration: 3 Months Location: Remote Job Description: * Reviews a completed prior authorization request received from the provider and/or reviews the pharmacy technician's recommended denial, suggested formulary alternatives, comments and attachments for appropriateness. * Verifies member's ID number and date of birth. * Verifies member's eligibility in the appropriate health plan eligibility system. * Records carrier and group number if applicable. * Checks for previous prior authorization decisions. * Verifies coverage in member's prescription benefit when necessary. * Verifies coverage in member's health plan benefit when necessary. * Evaluates prescription claim history. * Reviews chart notes and/or lab values. * Identifies provider specialty when appropriate. * Applies Medical Policy Criteria to prior authorization requests. * Evaluates whether request meets criteria for approval. * Reviews the request using professional clinical judgment on a case by case basis. A pharmacist will review medication requests not addressed by P&T Committee criteria or guidelines, develop and draft criteria for the non-formulary medication requested. * Researches and contributes drug references and clinical information to facilitate prior authorization review: directly to physicians via fax or phone encounter; or to pharmacy technicians via memo or on a personal level as an educational tool * Communicates with physicians regarding prior authorization: o For a non-formulary drug o Plan benefits, exclusions o Quantity limits o Age restrictions o Formulary alternatives * Retrieves and collects data through available reporting resources (i.e. Discoverer, IT Department) * Compiles data for reporting purposes: o Drug utilization of non-formulary drugs o Overturned IPS recommended denials o Audit pharmacy claims greater than $200.00 o Suggest addition or deletion of drugs to/from the formulary o Updating qty/days or age limit ends o Support National P&T Committee o Other tasks which may arise during the performance of any of the above mentioned duties
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